MicroRNA Profiling of the Pathophysiological Mechanisms Underlying Carotid Atherosclerosis Progression

Carotid atherosclerosis is a major contributor to ischemic stroke, driven by complex interactions between inflammation, lipid metabolism, and vascular dysfunction. MicroRNAs (miRNAs) have emerged as key regulators of the molecular mechanisms underlying plaque formation, progression, and instability. This review summarizes current evidence on the role of miRNAs in endothelial dysfunction, vascular smooth muscle cell proliferation, macrophage activation, and plaque vulnerability. Specific miRNAs, including miR-21, miR-145, and miR-200c, demonstrate context-dependent effects on atherogenic and protective pathways. Circulating miRNA profiles show strong potential as noninvasive biomarkers for assessing plaque instability and predicting cardiovascular ischemic events, and as promising therapeutic targets. Despite these advances, challenges remain in standardization and clinical implementation. Integration of multi-miRNA panels with imaging modalities, conventional biomarkers, and emerging artificial intelligence approaches may improve risk stratification and support personalized management of carotid artery disease.